Limited Improvements With Testosterone

Vital Signs
Nostrums: Testosterone and Sex Drive in Women
By ERIC NAGOURNEY
Published: April 22, 2008
Women who spray testosterone on their stomach to raise their sex drive may not see much benefit — unless they also want to grow hair on their belly.


Below is more from today's New York Times article on testosterone. So what do you think?
Vital Signs
Nostrums: Testosterone and Sex Drive in Women


Published: April 22, 2008
Women who spray testosterone on their stomach to raise their sex drive may not see much benefit — unless they also want to grow hair on their belly.

Safety and Efficacy of a Testosterone Metered-Dose Transdermal Spray for Treating Decreased Sexual Satisfaction in Premenopausal Women (Annals of Internal Medicine)

Writing in Annals of Internal Medicine, researchers said it was possible that the treatment held promise for premenopausal women experiencing a loss of sexual interest and satisfaction. But the study found only limited improvements, and the researchers said even these might have been caused by a placebo effect. Treatments containing testosterone are given for women whose sex drive diminishes after menopause; none are approved for those still menstruating, the study said.

For this study, 261 women who reported a decrease in sexual activity and had low testosterone levels were given one of four sprays and told to put it on their stomach for four months. Three sprays held varying levels of testosterone, and one was a placebo.

At the start the study, the women reported having four to five sexual encounters a month, with an average of 1.4 described as satisfactory. After 16 weeks, the women in all the groups reported a somewhat better sex life, although the increase was statistically meaningful only for the group that received the middle dose of testosterone. Unwanted hair growth where the spray was placed was fairly common.

The results, the researchers said, justify more research, but they cautioned against the widespread use of testosterone in premenopausal women for now.

Decreased Sexual Satisfaction Is Not Associated With Cardiovascular Disease

Decreased Sexual Satisfaction Is Not Associated With Cardiovascular Disease In Postmenopausal Women

This is interesting research and will appear in the April 2008 issue of The American Journal of Medicine. In men, erectile dysfunction is clearly linked to the developing of cardiovascular disease. Many of the same changes and risk factors for cardiovascular disease have been thought to be responsible for sexual problems in postmenopausal women, but this has not been researched using prospective data. This is an example of why women are not always mirror images of men when it comes to sexual health issues and medical conditions that could impact sexual health.


Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) and collaborators nationwide have found that decreased sexual satisfaction in postmenopausal women, is not clearly associated with cardiovascular disease. To read more,click here

TWSHF Advisor Talks About Menopause in MORE Magazine

Recently Dr. Hilda Hutcherson, a TWSHF advisor, was interviewed in the March 2008 MORE magazine issue concerning menopause. What was most enlightening and refreshing is to know that menopause can be hazardous to a man's health too. That is if he jokes about it. Apparently there is an increase fracture rate for men immediately after the joke is told.


Not Your Mother's Menopause


Hilda Hutcherson,
Many of our mothers didn't dare speak about "the change," even to their doctors. Today, information about hot flashes and night sweats flows freely from the press, and it's a relief -- it's fun, actually -- to share our experiences of menopots, insomnia, and other hormonal annoyances. MORE asked two experts to have a talk about menopause and let us listen in.

Hilda Hutcherson, MD, 52, is an ob-gyn and a professor of obstetrics and gynecology at Columbia College of Physicians and Surgeons, in New York.

Donnica Moore, MD, 46, is a women's health expert and advocate, and president of Sapphire Women's Health Group, a multimedia women's health education and communications firm.

MORE: What was your mother's menopause like?

HUTCHERSON: My mother's generation did not say menopause.

MOORE: The few times my mother broached the subject, she called it the change of life. She wouldn't utter the word to me -- and I was already a full-fledged doctor when she was going through menopause. She would ask me for help with her symptoms without ever saying it. Today, women are quite open and well-informed. The word is on the covers of magazines; it's on TV and in ads; it's everywhere.

HUTCHERSON: This openness is emblematic of how women in midlife handle other life events now too. We educate ourselves and are empowered by knowledge, we share experiences with our peers, and we make our choices.

MORE: Some women even talk about menopause as a rebirth. Do you agree?

HUTCHERSON: Oh, I agree. It is a rebirth. You finally wake up and say, I've spent my entire life taking care of everybody else. Now it's time to focus on me. Also, we are more confident. We know what we want and don't mind asking for it. My patients who are in their 50s have said that even though going through this transition can be difficult at times, it's still better than being in their 40s.

MOORE: Many women I talk to get what Margaret Mead called the postmenopausal zest. I once heard a woman say, "The blood is no longer going down, so it's going up to your brain," which is not biologically correct but is metaphorically pretty accurate.

MORE: But do you find there can be a sadness about the finality of it, particularly for women who never had children?

HUTCHERSON: I do find that with patients, and with friends, who did not have children. Often their reason for not having children was not finding the right partner.

MORE: The perfect guy never came along.

HUTCHERSON: So take Mr. Almost Perfect! My best friend fits this picture -- she's single and really regrets it and has gone though menopause. After she met my husband, she said, "How in the world could you fall in love with a man who wears polyester pants?" I said, "Honey, I can buy him different pants." She's looking for perfection and, of course, not finding it. But once your period stops coming, reality sets in. And it can be very depressing for women, except for the ones who decided years ago that they didn't want a baby. Women can do technological stuff now and get somebody else's eggs and have a baby. But eventually, the realization that motherhood is not going to happen comes along. I have four children, and when my menopausal symptoms started, even I felt a sense of sadness. It's the finality of it.

To read more click here

Hormone drugs had lasting breast cancer risk

Researchers chronicle the threat of estrogen and progestin three years after women in a study stopped the treatment.

By Thomas H. Maugh II, Los Angeles Times Staff Writer
5:10 PM PST, March 4, 2008

Three years after they stopped hormone replacement therapy, women who took the drugs still had a 27% higher risk of developing breast cancer than those who took a placebo, researchers reported today.

The women were participants in the Women's Health Initiative, halted abruptly in 2002 when researchers found that the doses of estrogen and progestin increased patients' risk for heart disease, stroke and breast cancer.

Although the heart risks eased after the women stopped taking the drugs, their overall cancer risk remained 24% above average.

"Menopausal women really need to think through whether using estrogen-progestin is the right thing to do, particularly if continued for more than a few years," said Marcia L. Stefanick, a professor of medicine at Stanford University and one of the authors of the paper appearing in the Journal of the American Medical Assn.

Physicians taking the medical history of a new patient past menopausal age should also "ask specific questions about past use of hormone therapy" and be alert for possible problems, said Dr. Robert W. Rebar, executive director of the American Society for Reproductive Medicine, who was not involved in the study.

"The important message is women really need to make sure they continue getting their mammograms," Stefanick said.

Some experts noted that hormone use has changed dramatically since 2002, with physicians prescribing lower doses for shorter periods of time. They are also giving the drugs to younger women -- a group that the Women's Health Initiative found was less likely to suffer adverse effects from the therapy.

"We really don't believe this latest article provides any new guidance," said Dr. Gary Stiles, chief medical officer of Wyeth Pharmaceuticals, which manufactures the Prempro used in the study. "We continue to recommend that it be used at the lowest effective dose for the shortest duration of time possible."

The Women's Health Initiative originally enrolled 16,608 women with an average age of 63 who were given either Prempro -- a combination of estrogen and progestin -- or a placebo. The goal was to determine whether the hormones could protect against heart disease.

But the study was stopped prematurely after an average of 5.6 years when it was determined that women taking the hormones had a 26% higher risk of breast cancer as well as an increased risk of stroke, blood clots and heart attack.

Subsequent analysis, however, showed that younger women beginning treatment at menopause around 50 did not share the increased risk.

Since 2002, the sales of Prempro have dropped from $2 billion a year to a little over $1 billion. Breast cancer rates have also fallen, and many experts attribute the decrease to lower rates of hormone replacement therapy.

The new study, funded by the National Heart, Lung and Blood Institute, followed 15,730 of the original trial participants for an average of three years after they stopped taking hormones.

The researchers found 281 cancers in the group receiving Prempro, compared to 218 in the placebo group, a difference driven primarily by breast cancers. The rate of deaths from all causes was 15% higher in the Prempro group, but the difference was not considered statistically significant.

There were 343 heart attacks, strokes and blood clots in the Prempro group and 323 in the placebo group, a statistically insignificant difference.

The benefits of Prempro observed in the original study, a lower risk of colorectal cancer and bone fractures, dissipated after hormone use was stopped.

At a news conference sponsored by Wyeth, Dr. Hugh S. Taylor of the Yale University School of Medicine cautioned that, with all the uproar over possible harm from hormone replacement therapy, physicians should not lose sight of the hot flashes, vaginal atrophy, sexual problems and insomnia associated with menopause.

"They can have a dramatic effect on women. Careers and relationships suffer," he said.

"It's important that we don't trivialize quality of life."

thomas.maugh@latimes.com

Agencies target female mutilation

By Laura Trevelyan
BBC News, New York


A range of United Nations agencies are calling for the practice of female genital mutilation to be ended within the space of a generation.

An estimated three million girls a year are thought to be at risk from this practice, many of them in Africa.

The practice of cutting off the clitoris of a young girl - and often more - is deeply rooted in some cultures.

Ten UN agencies want a major reduction in the tradition by 2015.

The practice is seen in some countries as a way to ensure virginity and to make a woman marriageable.

Yet it also leads to bleeding, shock, infections and a higher rate of death for the women's new-born babies, say the UN groups.

Communities urged

Up to 140 million women are thought to have undergone this procedure in 28 countries in Africa, and a few in Asia and the Middle East.

It is also happening to girls and women who have left their original countries and settled in the West.

The UN agencies say traditions are often stronger than law and legal action by itself is not enough to tackle this.

Change must come from within communities, they say, citing the example of West Africa, where villages have joined together to make pledges to abandon this practice.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7266174.stm

WOMEN MUST BECOME EMPOWERED TO ASK FOR MINIMALLY INVASIVE GYNECOLOGIC SURGERY, EXPERTS SAY

TWSHF was recently sent the below press release and more than likely, most women have not had an opportunity to educate themselves on the recent advances in the procedures that we have highlighted below. TWSHF firmly believes that your knowledge is your power. This release will add to your power base.


WASHINGTON, DC (November 19, 2007) -- Endoscopic techniques are transforming the practice of surgery, yet their adoption in certain specialties, particularly gynecology, lags far behind that of other specialties. For example, laparoscopic surgery for gall bladder removal reached an 80% adoption rate over the ten years since it was introduced, while laparoscopic hysterectomy is still used for less than 15% of the 600,000 hysterectomies annually performed in the United States. Reasons for the discrepancy include lack of patient education, lack of physician training, reimbursement issues, and reluctance of women to question their doctors, said experts at the 36th Annual Global Congress of Minimally Invasive Gynecology.

“Historically the AAGL has been devoted to introducing and testing new surgical techniques and educating surgeons how to perform endoscopic and laparoscopic procedures,” said Charles E. Miller, MD, President-Elect of AAGL. “Today we are broadening our mission to include education and empowerment of our patients.”

Highlighted at the meeting were new in-office procedures that replace the need for a woman to spend hours in a hospital operating room; the coming transformation of surgery through the use of robotics; and the miniaturization of surgical techniques in general as the medical profession leverages technological advances made by NASA, the military and the communications industry.

Procedures Move from Hospital to Office

Keith Isaacson, MD of Harvard Medical School and a surgeon at Newton Wellesley Hospital, MA, described three examples of procedures that once required several hours in an operating room, general anesthesia and days of recovery, but now can be done safely, effectively and without anesthesia in the physician’s office: hysteroscopy; permanent sterilization; and endometrial ablation.

Hysteroscopy is a diagnostic technique in which the physician uses a miniature “telescope” to view the inside of the uterus, frequently used to diagnose the cause of abnormal uterine bleeding (AUB), a condition responsible for 30% of all visits to the gynecologist. Today a woman can have this procedure in the comfortable and familiar surroundings of her gynecologist’s office and return to her work or other activities immediately thereafter. Similarly, one of the treatments for AUB – a procedure called endometrial ablation – now can be done in the doctor’s office, as can tubal occlusion, a treatment for permanent sterilization. This translates not only into health cost savings, but also reduced trauma and anxiety for patients. “When you reduce the stress level with any procedure, you have a better outcome,” said Dr. Isaacson.

Robotic-Assisted Laparoscopy Will Create “No-fly Zone”

According to Javier F. Magrina, MD of the Mayo Clinic in Scottsdale, AZ, the use of robotics in minimally-invasive techniques for gynecologic procedures is a major advance because of the increased precision and control it provides to the surgeon. “For the first time, the surgeon can sit comfortably at a console, become immersed in the patient via a 3-D image, and control the most minute and complex operations using robotic arms,” said Dr. Magrina. “In the future, the patient will be next to you in the room or thousands of miles away. All this is possible because of robotic-assisted laparoscopy.”

Advantages to the patient may include less blood loss, less trauma to tissue, quicker recovery with less pain, and less risk of damage to adjacent organs. According to Dr. Magrina, “Virtual biopsy is already being done and all of you in the room have contributed to the development of the instrument by NASA. It’s a little 18 gauge needle that has five different sensors on the tip of the needle. You can put it directly into a breast tumor without taking a biopsy and it will give you a curve of probability of whether that tumor is benign or not without taking an open biopsy.” In the future, Dr. Magrina said, robotic-assisted surgery will enable the creation of a “no-fly zone” – a designated area where the instruments simply will not go -- thus providing even greater protection of surrounding organs and tissues.

Miniaturization Heralds the Future

Marie Fidela-Paraiso, MD of the Cleveland Clinic, OH, described new, miniaturized techniques for the laparoscopic treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). SUI affects as many as one in nine American women and is often caused by POP, the “dropping” of the uterus after pelvic floor muscles become weakened by childbirth and age.

“Just as tension-free vaginal tape (TVT) revolutionized the treatment of SUI in the mid-1990s, the new mini-sling is a major treatment advance today, requiring only one tiny incision in place of three. With a 90% success rate, this procedure is comparable to earlier ‘gold standard’ methods,” said Dr. Fidela-Paraiso.

“The reduction in time and trauma means that the mini-sling procedure may soon move into the physician’s office. Like the prolapse repair kits, these miniaturized devices are helping more doctors transition to the use of newer procedures, improving patient care and the quality of life for many more women,” she added.

Miniaturization is changing the way medicine is practiced today and will continue to do so into the future, according to Steven Palter, MD of the North Shore University Hospital, NY. Dr. Palter described exciting potentials such as micro-invasive and non-invasive surgery, the use of microchip, miniaturized devices and autofluorescents to diagnose “invisible” conditions, and surgeons being trained on simulators just as astronauts are.

“In the past year we have seen as much innovation as we did in the previous ten years,” said Dr. Palter. “The field of medicine is undergoing the same kind of exponential progress as computer technology, which means that in ten years or less, the way we provide care to our patients will be radically different. Instead of a doctor standing in an operating room making a big incision and working with his hands, he will be more like a NASA commander on a Mars mission – remotely controlling a rover that travels through the body.”

Message to Women: “Ask”

Despite the availability of many new, less invasive treatments for gynecological problems, the majority of women do not benefit from these advances. For example, a significant percentage of the 600,000 hysterectomies done annually in the U.S. may be avoidable through the use of minimally invasive techniques for the treatment of fibroids, AUB and other common conditions.

In addition, half of these hysterectomies remove more than is necessary and perhaps more than is healthy, according to William Parker, MD of the University of California, Los Angeles, School of Medicine. “Half of all hysterectomies remove the ovaries, even when there is no cancer involved. We now know that after menopause, the ovaries continue to secrete hormones that help keep bones strong and hearts healthy.” said Dr. Parker. Dr. Parker believes that women should keep their ovaries whenever possible and if not should consider hormone replacement therapy.

Prior to the introduction of laparoscopic gynecologic surgery, it was also common to remove the cervix during a hysterectomy. “Now, however, we know that if we do a laparoscopic supracervical hysterectomy or LSH, we can leave the healthy cervix intact and thereby preserve the integrity of the pelvic floor,” Dr. Parker said.

“Women’s treatment choices should always include minimally invasive options,” Dr. Parker continued. “Women should not be afraid to ask for what they want or hesitate to pursue a second opinion.”

ACOG Statement on Alternatives to Hysterectomy

As always, TWSHF strongly suggests that women obtain a second and even a third opinion if a hysterectomy is recommended and that all other alternatives to a hysterectomy are discussed. Also, be sure to read the education brochure, Hysterectomy and Your Sexual Response at The Women's Sexual Health Foundation website-www.TWSHF.org.

ACOG NEWS RELEASE
For Release: August 29, 2003


ACOG Statement on Alternatives to Hysterectomy


Washington, DC -- Several recent news stories have presented inaccurate information concerning ACOG recommendations on when hysterectomy may be indicated. In particular, ACOG recommendations on the treatment of fibroids have been misrepresented. ACOG thus reiterates its long-standing advice provided in both patient and physician education materials.

Hysterectomy should only be performed for medical reasons, and only after alternative options have been discussed and explored with the patient.

If a physician advises a hysterectomy, women should consider getting opinions from one or more other physicians.

In the case of fibroids, which are non-cancerous tumors growing in or on the uterus, women may need to do nothing at all, particularly if the fibroids are not causing any problems. For women who are experiencing problems - such as pelvic pain, bleeding, or infertility problems - women and their physicians should rule out other causes of such conditions before treating fibroids.

In cases where fibroids cause problems, ACOG notes that there are other, less invasive alternatives to hysterectomy such as medications that temporarily shrink fibroids or a surgical procedure known as a myomectomy. This surgery removes the fibroids but preserves the uterus. Depending on the number and size of the fibroids, this may be done either through outpatient techniques such as hysteroscopy or with more invasive abdominal surgery that requires a hospital stay and recovery time equivalent to that of a hysterectomy. [See Guidelines for Women's Health Care, 2nd Edition, 2002; Surgical Alternatives to Hysterectomy in the Management of Leiomyomas, ACOG Practice Bulletin no. 16, May 2000.]

Medical science is also exploring other potential treatments, such as the newer uterine artery embolization (UAE) procedure. ACOG believes that more research is required before such procedures can be recommended as a routine treatment option, but ACOG is encouraged that an expanding number of treatment choices may be available in the future.

The allegations in some news stories that ob-gyns are motivated to perform hysterectomies for financial gain are not only untrue claims against physicians devoting their lives to improving women's health, but they are patently absurd in today's medical liability climate.

As in other health care matters, a woman's decision whether to have a hysterectomy is an individualized one, made after consultation between a woman and her doctor. Ob-gyns are women's partners in health care who believe that an informed patient can make the best choices about what is right for her.

Women wanting more information on these subjects may request our patient education pamphlets "Uterine Fibroids" (AP074) or "Understanding Hysterectomy" (AP008) by emailing resources@acog.org or calling 202-863-2518.

# # #

ACOG is the national medical organization representing 45,000 members who provide health care for women.